Womb for Rent

As Ilene Glickman approached her 40th birthday, she decided it was time to have the third child she'd always wanted. Already the parents of Cheryl, 12, and Andrew, 9, she and her husband, Steven, a dentist, didn't feel that their family was complete. Ilene, an owner of a children's clothing company in Boca Raton, FL, got pregnant three times—and miscarried three times because the lining of her uterus did not grow thick enough to sustain a pregnancy. Finally, she underwent several in vitro fertilization (IVF) attempts that failed but yielded seven embryos that she was then able to have frozen.

"Steve and I looked at each other and said, 'This is craziness,'" she remembers. "I had my embryos, but I couldn't carry them. I was devastated. But I wasn't about to give up."

Ilene figured her only chance to have a third biological child was to hire another woman, a surrogate, to carry it for her. She looked up surrogacy on the Internet and started to call agencies and lawyers all over the country, taking copious notes. She spent months investigating websites on the topic. Finally, over the Internet, she connected with a 23-year-old woman in California willing to carry a child for her. After six months of procedural screenings—psychological, legal and medical—it turned out that the woman had the same uterine-lining problem Ilene had.

Exhausted and depressed but still determined to expand her family, Ilene, now 45, put another ad on a surrogacy website. Among the five replies she received, one stood out: a young woman who sounded kind and compassionate, almost too good to be true.

Ilene e-mailed her immediately and throughout the next 24 hours got to know her online. She learned that the potential surrogate's name was Carrie Russell, she was 24, and she was a deeply spiritual person who believed that when one door closes, another opens: Although she'd lost an ovary at 17, Russell was able to conceive her daughter, now 6, but then developed endometriosis. After seven surgeries to correct it, she had her son, now 4. "It was a miracle," says Russell, who lives in Toledo. "I wanted to give something back." What could be more important, she thought, than giving life? Ilene knew she'd found the person who would bear her third child.

A Controversial Choice

Even though it's been 22 years since the first documented surrogate birth took place, the practice continues to raise eyebrows. There are still difficult issues to consider, but a lot has changed between those days—when the heart-wrenching story of Mary Beth Whitehead's 1985 surrogacy case covered the front pages of every newspaper—and two summers ago, when a radiant 52-year-old Cheryl Tiegs announced the birth of her twin boys by a surrogate. During that time, there have been an estimated 14,000 to 16,000 surrogate births (the number isn't exact because many take place between friends and family without agencies or lawyers to document them).

The largest increase has occurred in the past five years, as technology and success rates have improved and the practice of "gestational" surrogacy has emerged. The prospective parents' sperm and egg are used to create embryos outside the womb that can then be transferred to the surrogate's uterus, or, as in Ilene Glickman's case, leftover frozen embryos can be used. If a woman can't supply her own eggs, couples often opt for anonymous donor eggs or embryos rather than have the surrogate maintain a genetic link to the baby. (This was the case in traditional arrangements, in which the surrogate's eggs were fertilized with the intended father's sperm.) Today more than 95 percent of surrogate arrangements are gestational, says Karen Synesiou, director of the Center for Surrogate Parenting, in Beverly Hills, CA, which facilitates 85 to 100 such births a year.

Another reason for the rise in surrogate births is that they can be faster than adoption, says Joan Barnes, who runs The American Surrogacy Center (TASC) website (www.surrogacy.com); her two boys were carried by the same woman. And during a surrogate pregnancy, there's intense scrutiny and monitoring of prenatal care, so prospective parents feel that they have more reliable information about the health of their child.

Typically, the parents and the surrogate enter into a carefully worded contract that outlines the health responsibilities and expectations of each party. But even this doesn't erase what most people would consider the biggest drawback: the fear that the surrogate mother won't want to relinquish the baby after it's born. This has happened only 23 times since 1979. In those cases, some surrogates genuinely wanted to keep the baby because of an emotional bond, but for others it was an attempt to negotiate better terms. Almost every time, the issue was eventually resolved in favor of the intended parents, even when the child was genetically linked to the surrogate, says Andrew Vorzimer, a lawyer in Beverly Hills who specializes in third-party reproductive law.

In fact, it's more likely that the parents-to-be will have second thoughts. There have been 65 such situations in the past 20 years. Many of those couples changed their minds because they divorced prior to the birth, with one partner wanting the baby but the other unwilling to be responsible for child support, says Mark Johnson, an Atlanta lawyer who's written extensively on surrogacy law. Or there were premature births, without insurance coverage, and the intended parents were reluctant to pay for extended hospital care. Just last August, a couple in California attempted to back out of an arrangement with a surrogate who refused to abort one of the twins she was carrying for them.

The courts have usually responded by recognizing the responsibility of the intended parents. But "without question," says Vorzimer, "it's the surrogate who has to worry, 'How do I know you'll take this child?'"

Steven Glickman was skeptical at first that a surrogate would relinquish their child. "You hear about people who change their minds midstream. It's a tremendous leap of faith," he says. But then he and Ilene flew to Ohio to meet Russell, who insisted that she wouldn't want to keep their baby. "I knew I could do it because there were no genetic ties to me," Russell says. "Friends would ask, 'How could you give the baby away?' and I said, 'It's not mine to give away. It's like I'm being a babysitter.'"

Says Steven, "Once I met her, I knew it would be all right. This is something she was meant to do."

Maternal Motivations

Some women see surrogacy as a way to do something important in life, says Shirley Zager, director of the Organization of Parents Through Surrogacy (OPTS). Zager used a surrogate 14 years ago to have her daughter, Amy, and when she asked the woman why she was doing it, she replied, "I can't cure cancer or end world hunger. But I can make a very dramatic difference in the world."

Susan Jones, owner of Surrogate Parenting Consultants, the California agency that Russell and Ilene Glickman used, has had women call her agency to be surrogates without even knowing they'll get paid. Others have asked for less than the usual fee ($15,000 to $25,000) because they think it's too high.

In fact, the compensation is low considering what it takes to carry someone else's child. If you calculate the trips to doctors and clinics, the daily shots, the time away from your family, the screenings, the medical procedures, and the labor and delivery, she says, "the salary's probably about two dollars an hour."

Surrogates often view their earnings as a nest egg for their kids' college education or as a way to make money while caring for their own families. A combination of altruism and financial pull is what psychologists want to see when they screen potential surrogates because a woman whose motives are balanced and healthy will be better able to deal with the emotional aspects of carrying, delivering, and then parting with someone else's child.

Regardless, it appears that most surrogate moms wind up having mixed emotions about their experience, even years afterward, says Nancy Reame, Ph.D., a researcher in the University of Michigan's department of reproductive sciences who has studied traditional surrogates. Many report feelings of sadness, disappointment, and abandonment by the couples they'd helped and "are surprised at the depth of loss and grief they feel for the baby they'd carried," says Reame. Because gestational surrogacy is relatively new, there's been little study of its effect on women; it's hard to say how its emotional repercussions will compare with those of traditional surrogacy.

Couples who turn to surrogacy face their own set of fears, frustrations, and challenges. The cost alone can be a major obstacle, as agency fees range from $6,000 to $18,000. Then there are psychological screenings, medical screenings and procedures, legal fees, insurance fees, maternity clothes, obstetrical costs, and lost wages for the surrogate if she must leave work. The total can add up to as much as $75,000.

And, says David Smotrich, M.D., a reproductive endocrinologist in La Jolla, CA, there's the physical stress a woman undergoing the first phase of IVF endures: weeks on medications to stimulate her ovaries to produce large quantities of eggs; the retrieval of those eggs, which usually involves general anesthesia; and the constant monitoring.

Turmoil, Triumph—and Twins!

Carrie Russell proved to be more than just a willing womb. She quickly became Ilene Glickman's friend, confidant, and voice of reason. When the embryos were thought to be missing for three days, Russell kept reassuring Ilene that everything would work out—and it did. The embryos hadn't been sent, which turned out to be a blessing—their destination was hit by a tornado during those three days.

After the transfer of five embryos into Russell's uterus, three implanted, but one of the resulting fetuses had a weak heartbeat and was half the size of the others; it miscarried at eight weeks. From then on, the pregnancy proceeded normally. Alexa and Ryan arrived the day after Christmas in 1999, with the Glickmans cheering Russell on throughout her six-hour labor. The new parents cried as their babies came into the world. "It was a very emotional, very spiritual experience," says Ilene.

The next day brought more tears when the Glickmans surprised Russell at the hospital with a bouquet of roses and announced that they had set up mutual fund accounts for the college education of Russell's two children. And Russell later had a surprise for the Glickmans: a day-by-day diary she'd kept of the pregnancy, which included her own hopes and dreams for the babies, bound into a book to be given to them.

Now Ilene and Russell correspond every couple of weeks via e-mail, and Ilene frequently sends Russell pictures of the twins. The first Mother's Day after they were born, she included a card, thanking Russell for her babies. "You have made my dreams come true, and I consider myself a very lucky lady," she wrote. "Revel in the fact that you have made one mother in south Florida deliriously happy."

How Surrogacy Works

There are three facets to most arrangements with surrogate mothers. It's vital that each is carried out:

1. THE MEDICAL PROCESS

Once tests determine that the surrogate is capable of carrying a pregnancy to term and that the intended mother's eggs are of good quality (the father's sperm is also analyzed), the women are put on medication to get their cycles in sync. Typically, this means six weeks' worth of daily hormone injections for the surrogate and three weeks of daily hormone injections to stimulate egg production for the mother.

If a pregnancy is achieved after the eggs are retrieved and fertilized (over three to five days) and embryos are transferred to the surrogate, she must continue to take daily hormone injections for another 12 weeks.

2. THE PSYCHOLOGICAL PROCESS

Potential surrogates working through an agency are required to complete a lengthy personality-profile questionnaire and to meet with a staff psychologist. Most psychologists screen for someone who's motivated by both altruism and financial gain, who enjoyed being pregnant (if she has been before) and had a healthy pregnancy, who has support from family and friends, and whose religious beliefs accept surrogacy. Surrogates must also be able to deal with the stress brought on by the medical aspect of surrogacy and to separate emotionally from the baby. Karen Synesiou of the Center for Surrogate Parenting, in Beverly Hills, CA, says that of the 400 calls she gets each month from women interested in becoming surrogates, only about 10 are accepted after the psychological screening.

Beyond that, the surrogate must be matched to a couple with whom she shares the same beliefs regarding termination of a pregnancy if medically indicated, selective reduction if there are more fetuses than expected, and the amount of contact between the intended parents and the surrogate during the pregnancy and after.

3. THE LEGAL PROCESS

Each state differs in its recognition of surrogacy arrangements. In New York, surrogacy contracts are illegal. In New Jersey, it's legal to have someone carry a child for you, but it's against the law to pay her. Some states don't recognize the intended parents' right to have their name on the birth certificate and require that they legally adopt the child, even though biologically it's theirs. Other states, such as California, are highly favorable to surrogacy. These differences make it important for couples and surrogates to work with a reputable agency or, if putting together a private arrangement, a strong team of experts (doctors, psychologists, and lawyers familiar with state laws), says Mark Johnson, an Atlanta attorney who's written extensively about surrogacy law.

Debra Morgenstern Katz has written for The New York Times as well as national magazines.